Chapter 4: Delivering quality, personalised care
To deliver high-quality care, providers must understand and respect people's needs, attitudes and concerns. There is growing evidence that, by personalising care and involving people in decisions about their health and care, we will improve health and wellbeing, improve quality of care, and ensure more informed use of healthcare resources.
It is well documented that the health and social care system is facing unpredicted demands due to demographic and financial pressures, technological advances, and changing attitudes towards people wanting to be more in control of their health and wellbeing.
Issues affecting quality of care extend beyond the delivery setting and include personal, social and cultural factors. Research highlights the benefits of addressing client perspectives on quality of care, since it leads to improved client satisfaction, continued and sustained use of services, and improved health outcomes. This chapter discusses meeting the needs of specific groups where existing gaps are not being addressed, such as men and boys; women and girls; and lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ+) people.
Access to gender-specific services
Increasingly over the past 15 years, a focus on the mental health needs of men has encouraged the expansion of organisations that support and work with men to improve their mental health and wellbeing. The Australian Bureau of Statistics reports that, of the 3,318 registered suicide deaths recorded in Australia in 2019, 2,502 (75.4%) were of males and 816 (24.6%) were of females. Additionally, according to the Australian Institute of Health and Welfare, 10.7% of Australians received Medicare-subsidised mental health–specific services in 2019–20, an increase from 6.2% in 2009–10; 12.8% of Australian females accessed these services, compared with 8.5% of Australian males, in 2019–20. Australians aged 18–24 years had the highest rate of use of such services(15.3%).
Research has indicated that the system needs to provide access to gender-specific services if it is to improve mental health among men. The impact of COVID-19 means that some targeted services have been expanded, including increased funding provided to the Men's Referral Service and MensLine Australia. MensLine Australia provides phone and online counselling support for men with emotional and relationship concerns, alongside its Help is Here campaign. Services such as The Men's Table, Mates in Construction, Men's Sheds and Man Walk have adapted service provision to meet the needs of men by focusing on goals and solutions rather than talking about emotions.
To better understand and hear directly from men on mental health and suicide prevention, the Men's Health Connected Online Summit facilitated a recent national discussion in June 2020. Where men are not using traditional face-to-face sessions, flexible and innovative services should be considered, including online and telephone service delivery, which may provide greater access for men living in rural and remote Australia.
Critical life points experienced by women and girls, such as puberty, pregnancy, motherhood and menopause, can result in poor mental health. In addition, situations typically associated with women can lead to anxiety and depression, including infertility and perinatal loss, being a primary caregiver, relationship breakdowns, violence or abuse, discrimination, unemployment or underemployment, isolation and socioeconomic disadvantage.
It is estimated that approximately 1 in 5 women in Australia will experience depression, and 1 in 3 women will experience anxiety during their lifetime. The Australian Longitudinal Study on Women's Health (also known as Women's Health Australia) is a population-based survey that explores the factors contributing to the health and wellbeing of more than 57,000 Australian women in four age cohorts: those born in 1989–95, 1973–78, 1946–51 and 1921–26. The 1989–95 cohort had a higher percentage of conditions identified over their lifetime (51.2%) than older cohorts.
Mental health is a priority health issue in the national gender-specific health strategies for males and females (see Box 15). Each strategy embodies an understanding of how gender intersects with social, economic, environmental, political and cultural determinants of health, influencing exposure to risk factors and interactions with the health system.
Box 15: National gender-specific health strategies
The National Men's Health Strategy 2020–2030 and the National Women's Health Strategy 2020–2030 aim to address the different biological and societal factors that impact in different ways on women's and men's health and wellbeing. They aim to strengthen and improve national approaches for men and women by working in tandem with each other, and with other national, state and territory policies and strategies.
Mental health is a priority health issue in both strategies, with a life course approach for specific intervention points to increase the effectiveness of health education, intervention and service delivery. The National Women's Health Strategy 2020–2030 has five priority areas, including mental health. Within the mental health priority area, five key areas for action have been identified to improve mental health outcomes for women and girls in Australia. These are enhancing gender-specific mental health awareness, education and prevention; focusing on early intervention; and investing in service delivery and multifaceted care.
Acknowledging the unique needs of different population groups is a key element of each strategy; priority populations are recognised, and targeted interventions are identified to improve health outcomes. The population groups that experience a relatively high burden of adverse health outcomes (such as those living in rural and remote areas, Aboriginal and Torres Strait Islander communities, people from lower socioeconomic backgrounds, people affected by the criminal justice system, veterans, and members of the LGBTIQ+ community) may also differ for men and women. To improve health equity, each strategy has targeted interventions to address the complex, multidimensional needs of these priority population groups.
Research is needed to examine the differences in how men and women engage with, and respond to, psychological treatment, as there is limited research reporting on intervention effectiveness by gender. The Million Minds Mental Health Research Mission is funding research into projects on suicide prevention for boys and men, including interventions to assist with help seeking, online and telephone services, and suicide prevention (specifically in new fathers). In addition, mental health professionals require education on the role of gender and its implications on mental health treatment practices.
The Commission supports the conclusions in both the National Men's Health Strategy 2020–2030 and the National Women's Health Strategy 2020–2030 of the importance of monitoring and reporting on progress in implementing actions over the 10-year lifespan of the strategies. Of particular importance is reporting on the success factors that support gender-based activity, focusing on equity and access to mental health care for women and men at greater risk of poor mental health outcomes. These include people who are homeless, people with low financial security or financial literacy, people living in rural and remote areas, Aboriginal and Torres Strait Islander people, veterans transitioning from service, migrant and refugee people, and the LGBTIQ+ community.
Lesbian, gay, bisexual, transgender, intersex and queer communities
Services are needed that ensure safety for those who identify as LGBTIQ+, and provide supported outreach within this population and enable appropriate care regardless of the service accessed. As a minority group, LGBTIQ+ people disproportionately face negative mental and physiological health outcomes compared with the general population. LGBTIQ+ people continue to experience routine discrimination, prejudice, stigma and exclusion in the community.
It is difficult to determine suicide mortality rates for LGBTIQ+ people because sexuality and gender identity may be unknown. A recent study by La Trobe University indicates alarmingly high rates of suicide distress facing LGBTIQ+ people—they reported suicidal thoughts over the past 12 months at a rate 20 times higher than the general population. A number of studies have found that members of LGBTIQ+ communities are more likely to experience mental distress, such as anxiety, depression, thoughts of suicide, suicide attempts and self-harm than their non-LGBTIQ+ peers, as a result of negative social experiences such as homophobia and bullying.
Early interventions must aim to reduce known psychosocial risk factors for this population while enhancing protective and resilience factors. The La Trobe University study recommends research and evaluation of interventions and programs around suicide ideation, homelessness, AOD issues, and intimate partner and family violence in relation to people from the LGBTIQ+ community.
The Productivity Commission's report recognised the need to improve access to appropriate services, and to have a well-trained workforce to provide high-quality and culturally safe services for all Australians.
Some LGBTIQ+ people underutilise health services and delay seeking treatment because of actual or anticipated experiences of stigma and discrimination from service providers. It is crucial that services are affirming of sexuality and gender identity, and attentive to the particular pressures experienced by LGBTIQ+ people.
The Commission believes that the specific needs of LGBTIQ+ people who have experienced stigma and discrimination in the community and while accessing health services should be addressed as part of the National Stigma and Discrimination Reduction Strategy.